J. Rutka et S. Lekagul, NO THERAPY - USE, ABUSE, EFFICACY, AND MORBIDITY - THE EUROPEAN VERSUS THE THIRD-WORLD EXPERIENCE, Journal of otolaryngology, 27, 1998, pp. 43-48
Objective: Historical controls documented a marked reduction in compli
cations from acute otitis media (AOM) and chronic suppurative otitis m
edia (CSOM) with the introduction of antibiotic therapy in the period
1930 to 1950s amongst other changes that occurred in North American an
d Western European society. Today, the natural history of spontaneous
remission in AOM in over 80% of children within 24 hours of presentati
on questions the raison d'etre for the routine prescription of antibio
tics for what may essentially be a self-limiting condition. Metaanalys
es of numerous antibiotic versus placebo trials in the treatment of AO
M have demonstrated little difference in clinical outcome, as have tre
atment stratagems where antibiotics have been initially withheld. More
judicious use of antibiotic therapy in AOM appears to have been assoc
iated with a decline in antimicrobial resistance in countries such as
the:Netherlands and Iceland. It is difficult to know, however, whether
the direct savings from decreased antibiotic use will ultimately lead
to an actual decrease in the other direct and indirect costs associat
ed with AOM. Unfortunately, children in the third world have not exper
ienced a corresponding decline in ear disease. Significant loss of dis
ability-adjusted life years (DALYs) continues to occur from otitis med
ia. Withholding antibiotic therapy in the treatment of AOM would more
than likely impose greater morbidity and mortality on an already disad
vantaged population. Nevertheless, the experience of the Thai Rural Ea
r Nose and Throat Foundation has been seminal in documenting and affec
ting change in both the morbidity and mortality patterns of AOM and CS
OM during Thailand's transition toward developed nation status. This a
rticle analyzes these issues and provides a review of the literature a
vailable.